Abstract
Cardiovascular disease (CVD) primordial prevention tools applicable to diverse populations are scarce. Our aim was to assess the performance of a lifestyle-based tool to estimate CVD risk in an African American population. The Jackson Heart Study is a prospective cohort including 5306 African American participants in Jackson, Mississippi (2000–2004), with a mean follow up of 12 years. The Healthy Heart Score is a lifestyle-based CVD risk prediction model based on nine components: body mass index (BMI), physical activity, smoking, and a 5-component diet score. Gender-specific beta coefficients from its derivation cohorts were used to assess the performance of the Healthy Heart Score. Model discrimination was assessed using Harrell’s C-Index for survival data and time dependent Area Under the Curve. Model calibration was evaluated through calibration plots. A total of 189 CVD events occurred. The Healthy Heart Score showed high-moderate discrimination for CVD events (C-statistic 0.75 [95% CI, 0.71–0.78]) but with little improvement over the age-only model. Both the age-only and Healthy Heart Score models had better performance in participants without diabetes at baseline and showed good calibration. In African Americans, the Healthy Heart Score does not improve prediction of mid-life CVD events beyond what is obtained by age alone.
Highlights
African Americans have a disproportionally higher risk of cardiovascular disease (CVD) compared to non-Hispanic white adults [1,2,3]
In the NHS/HPFS [13], around 20% of the participants had hypertension or hypercholesterolemia while in the Jackson Heart Study (JHS), the prevalence of hypertension was close to 50%, and body mass index (BMI) was considerably higher (JHS: ~31 kg/m2 vs. NHS/HPFS: ~25 kg/m2)
The fact that the NHS and HPFS the group with clinical risk factors showed lower C-statistics suggests that the Healthy Heart Score works better in participants without clinical risk factors
Summary
African Americans have a disproportionally higher risk of cardiovascular disease (CVD) compared to non-Hispanic white adults [1,2,3]. Fox et al [5] developed and assessed several risk estimation algorithms for all CVD in more than 5000 African Americans from the Jackson Heart Study (JHS) cohort, and concluded that the current Framingham Risk Score [6,7] and the pooled cohort risk algorithms [8] worked well in Blacks so that a distinct calculator might not be necessary These prediction tools [5,9,10] include clinical risk factors such as blood lipids or blood pressure to estimate an individual’s ten-year risk of CVD, which often underestimate risk burden in young adults (
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